Germaine Lawrence is a residential treatment center for girls ages 12-18 with complex behavioral, psychological and learning challenges. Girls live at our programs while receiving special education, individual, family and group therapy; psychiatric and primary medical care; and a wide variety of therapeutic activities and interventions. read more >>

CA-MHSU 1: Service Philosophy, Modalities, and Interventions

sets forth a logical approach for how program activities and interventions will meet the needs of service recipients;

ensures that services are strengths-based, person- or family-centered, culturally and linguistically responsive, and trauma-informed;

guides the development and implementation of program activities and services based on the best available evidence of service effectiveness; and

outlines the service modalities and interventions that personnel may employ.

Interpretation:A functional service philosophy, logic model, or similar framework guides program development and implementation by linking the organization’s mission or purpose with strategies, practices, or tools needed to integrate these into daily work. A well-defined and visible practice framework will help staff, volunteers, and stakeholders think systematically about how the program can make a measureable difference by drawing clear connections between program values, service population needs, available resources, program activities and interventions, program outputs, and desired outcomes.

Interpretation: Organizational self-assessments can evaluate the extent to which organizations’ policies and practices are trauma-informed, as well as identify strengths and barriers in regards to trauma-informed service delivery and provision. For example, organizations can evaluate staff training and professional development opportunities and review supervision ratios to assess whether personnel are trained and supported on trauma-informed care practices. Organizations can also conduct an internal review of their assessments and service planning processes to ensure that services are being delivered in a trauma-informed manner.

Interpretation: Detoxification programs are focused on withdrawal management. The primary goal is to stabilize service recipients so that they can transition to a substance use treatment program. The service philosophy should reflect the primary focus of the program and outline any limitations to service delivery based on the program model. For example, depending on the level of care, family involvement may not be appropriate throughout the duration of treatment.

Rating Indicators

1

All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice standards.

2

Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice standards; e.g.,

Minor inconsistencies and not yet fully developed practices are noted, however, these do not significantly impact service quality; or

Written service philosophy needs improvement or clarification; or

Procedures need strengthening; or

With few exceptions procedures are understood by staff and are being used; or

Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations (CA-HR 6.02) and training (CA-TS 2.03); or

In a few rare instances required consent was not obtained; or

Monitoring procedures need minor clarification; or

With few exceptions the policy on prohibited interventions is understood by staff, or the written policy needs minor clarification.

3

Practice requires significant improvement, as noted in the ratings for the Practice standards. Service quality or program functioning may be compromised; e.g.,

Documentation is inconsistent or in in some instances is missing and no corrective action has not been initiated; or

Required consent is often not obtained; or

A few personnel who are employing non-traditional or unconventional interventions have not completed training, as required; or

There are gaps in monitoring of interventions, as required; or

Policy on prohibited interventions does not include at least one of the required elements; or

Service philosophy is not clearly related to expressed mission or programs of the organization; or

One of the Fundamental Practice Standards received a rating of 3 or 4.

4

Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice standards; e.g.,

There is no written service philosophy; or

There are no written policy or procedures, or procedures are clearly inadequate or not being used; or

Documentation is routinely incomplete and/or missing; or

Two or more Fundamental Practice Standards received a rating of 3 or 4.

Table of Evidence

Self-Study Evidence

On-Site Evidence

On-Site Activities

Service philosophy

Procedures for the use of therapeutic interventions

Policies for prohibited interventions

Documentation of training and/ or certification related to therapeutic interventions

Interview:

Clinical or program director

Relevant personnel

Individuals or families served

Review case records

CA-MHSU1.01

The program is guided by a philosophy that provides a logical basis for services and support to be delivered in a trauma-informed and culturally and linguistically responsive manner, based on program goals and the best available evidence of service effectiveness.

Interpretation: Services and support should be tailored to meet the individualized needs and goals of service recipients.

Research Note: Organizations that are trauma-informed recognize the signs and symptoms of trauma, and respond by applying the six principles of a trauma-informed approach:

safety;

trustworthiness and transparency;

peer support;

collaboration and mutuality;

empowerment, voice, and choice; and

cultural, historical, and gender issues.

Research Note:Providing services in a culturally and linguistically responsive manner is a strategy for combating health disparities and improving health outcomes for diverse populations. National standards on the provision of culturally and linguistically appropriate services have been developed to help organizations better serve increasingly diverse communities.

FP

CA-MHSU1.02

Prior to providing any therapeutic interventions, the organization:

explains any benefits, risks, side effects, and alternatives to the service recipient or a legal guardian;

obtains the written, informed consent of the individual or his/her legal guardian;

ensures that program personnel receive sufficient training, and/or certification when it is available; and

monitors the use and effectiveness of such interventions.

Related

Interpretation:Organizations that choose to engage in modalities or interventions that do not have an established evidence-base should ensure that practices do not cause physical or psychological harm by demonstrating in their procedures that they have acknowledged the potential risks of implementing such methods and subsequently taken appropriate measures to minimize risks.

Research Note: Complementary and alternative medicine (CAM) techniques, also known as complimentary health approaches, are products and practices that are not considered part of conventional medicine including, for example, massage therapy, movement therapy, hypnosis, acupuncture, meditation, yoga, and aromatherapy. While CAM is commonly associated with physical health, alternative therapies are being integrated into behavioral health. A growing body of evidence suggests that mind-body practices, such as mindfulness meditation and yoga, can enhance quality of life, decrease psychological stress, and improve mental health outcomes.